Free How Doctors Think by Jerome Groopman

blood pressure. His heart was holding up now despite all the Adriamycin. His platelet count had fallen, as often happens in septic shock, and he was receiving platelet transfusions. The senior doctor in the ICU had already told Brad's parents how serious his situation was. I saw them sitting in a room next to the ICU, their heads bowed. At first I considered walking by, since they had not seen me, but I forced myself to go in and offer a few words of encouragement. They thanked me for my care of their son.
    After a restless night, I arrived early the next morning before the residents on the ward to review all the charts of my patients. Rounds lasted an hour longer than usual, as I checked and double-checked every bit of information the team offered. I could see them growing restless, but I needed to reclaim my balance and this was the only way I knew how.
    Brad Miller survived. Slowly his white blood cell count increased, and the infection was resolved. After he left the ICU, I told him that I should have examined him more thoroughly that morning, but I did not explain why I failed to. His CT scan showed that the sarcoma had shrunk enough for him to undergo surgery without amputation. But a large portion of his thigh muscle had to be removed along with the tumor. After his surgery, running was too demanding. Occasionally I would see Brad riding his bicycle on campus, and I gave silent thanks each time I did.
     
     
    One of the most celebrated statements in clinical medicine comes from a lecture delivered by Dr. Francis Weld Peabody of Harvard Medical School in 1925: "The secret of the care of the patient is in caring for the patient." This is undoubtedly true, but less obvious than it may seem. Peabody cautioned doctors about the way their training conditions them. Of necessity, we learn to suppress our emotions, to block our natural reactions to many of the awful things we see and the brutal things we must do.
    Consider what happens in the ER when we try to save the life of a person smashed by a car or burned in a fire. If a doctor thought too much about the person before him, he couldn't insert his gloved hands into a hemorrhaging abdomen or maneuver a breathing tube past charred flesh. Even in less desperate circumstances—giving chemotherapy to a young woman with widespread breast cancer, say, or inserting a dialysis shunt into the arm of a blind diabetic whose kidneys have failed—we have to detach ourselves from anguish that could impede our work. But to become immune to feeling, as Peabody indicated, is to diminish the full role of the physician as a healer and relegate him to a single dimension of his job, that of a tactician. If we feel our emotions deeply, we risk recoiling or breaking down. If we erase our emotions, however, we fail to care for the patient. We face a paradox: feeling prevents us from being blind to our patient's soul but risks blinding us to what is wrong with him.
    I asked Dr. Karen Delgado about this paradox. Delgado is an acclaimed specialist in endocrinology and metabolism at a large urban teaching hospital who cares for patients with hormonal and metabolic disorders such as diabetes, infertility, and hypothyroidism. To my mind, she is the very model of a doctor, deeply knowledgeable about medical science and compassionate, empathetic, and generous with her patients. When I asked Delgado whether she had ever made an attribution error, she readily recalled a patient from her training in the 1970s. A young man was brought to the emergency ward of the hospital in the wee hours. The police had found him sleeping on the steps of a local art museum. He was unshaven, his clothes were dirty, and he was uncooperative, unwilling to rouse himself and respond with any clarity to the triage nurse's questions. Dr. Delgado was busy that night attending to other patients, so she "eyeballed" him and decided that he could stay on a gurney in the corridor, another homeless hippie who would be given breakfast in